what tests for diagnosis

[Littlefoot1thyroiduk]

I have just been diagnosed with Hyperthyroidism on basis of blood tests ( TSH low ( 0.02mIU/L ; / free T3 high high 10.4pmol/L ) , rapid weight loss, and very tired . Only been seen by GP; spoke to consultant by phone - to be told won't get full assessment for some time ( months) , get repeat blood test of TSH and free T3 Plus this time TSH receptor antibody test to determine if Graves disease or not is causing the Hyperthyroidism. have been told to take 10mg of carbimazole until see the consultant in person.

I can't wait to determine if Graves disease or not and ideally I'd really like to know what is the cause and so treatment .

I am considering firstly private blood tests and want to be clear what I need to ask for - I see TSH receptor antibody (TRAb) is the gold standard to test for Graves disease but many other terms other than that are used eg with Thriva company tests :

Triiodothyronine (FT3)

Thyroid-stimulating hormone (TSH)

Thyroglobulin antibodies (TgAB)

Thyroid peroxidase antibodies (TPOAb)

Thyroxine (T4)

Free thyroxine (FT4)

So I am confused and don't want to waste my money/ time . So is the TRAB test the same as the Thyroid Peroxidase Antibodies (TPOAb) ? If not what do I need to ask for please - any suggestions / links ( I have been reading a lot - but am still confused ! So if there's some easy to understand sources that explain my dilemma that would be great !)

Many thanks

😊

[SlowDragon Administrator]

welcome to the forum

Do you also have Ft4 result?

Was test done early morning

There are two types of autoimmune thyroid disease

Graves’ disease- true hyperthyroid autoimmune disease. Must be confirmed by testing TSI or Trab antibodies.

Hashimoto’s - autoimmune hypothyroid disease.

Confusingly Hashimoto’s frequently starts with transient hyperthyroid results and symptoms before becoming increasingly hypothyroid. The temporary high thyroid levels caused by cells in thyroid breaking down after autoimmune attack and releasing excess thyroid hormones. It’s not true hyperthyroid and can swing to hypothyroid in few weeks/months

Recommended that all thyroid blood tests early morning, ideally just before 9am. This gives highest TSH (Patient to patient tip)

Essential to also test vitamin D, folate, ferritin and B12.

These are often low with Graves’ disease or Hashimoto’s

Do you have recent vitamin D, folate, ferritin or B12 results?

Private tests are available as NHS currently rarely tests antibodies or all four vitamins

List of private testing options and money off codes

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus TPO and TG antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes TPO and TG antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins then cheapest option for just TSH, FT4 and FT3 and includes BOTH TPO and TG antibodies -£29 

randoxhealth.com/at-home/Th...

Link about Graves’ disease

thyroiduk.org/hyperthyroid-...

Graves Disease antibodies test via Medichecks

Has to be done via private blood draw, not DIY finger prick test

medichecks.com/products/tsh...

Only do private testing early Monday or Tuesday morning. 

Link about thyroid blood tests

thyroiduk.org/getting-a-dia...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism 

thyroiduk.org/wp-content/up...

Gluten intolerance is often a hidden issue with Hashimoto’s or Graves’ disease

Request coeliac blood test BEFORE considering trial on strictly gluten free diet

[PurpleNails Administrator]

Welcome to forum

No TPO & TRab are different.

Names of thyroid antibodies

TPOab (Thyroid Peroxidase antibodies) 

TGab (Thyroglobulin antibodies)

TRab (TSH receptor antibodies - measures stimulating, neural & blocking antibodies)

TSI (Thyroid-Stimulating Immunoglobulin)

TPO & TG antibodies signify autoimmune & appear in Hashimoto’s & Graves. 

Graves is confirmed by testing TRab or TSI & they are expensive specialist tests & need to be venous draw ( not DIY finger prick) If specialist is arrange TRab - might be worth waiting to see results - or allow a few weeks and test thyroid function.  TPO & TG antibodies & key nutrients (folate, ferritin, B12 & vitamin D) eg Medichecks thyroid advanced.  

thyroiduk.org/help-and-supp...

See list of companies & discounts.

GPs can arrange thyroid function, TPO & TG antibodies test & nutrients but often they are firm that specialist should arrange all test & treatment. 

Do you have FT4 (free thyroxine) result.   The FT3 (free triiodothyronine) is the powerful active thyroid hormone, many doctors / labs don’t test it as the view TSH most important.   Do you have lab range? Ranges vary between labs & by most ranges your FT3 is high but not too worrying high.  

We often see higher with Graves, typically 3x the normal range. 

Graves is continuous & Hashimoto’s (thyroiditis) cause transient hyper before gradual lowering of function - both autoimmune

You have been given a low starting dose, of 10mg carbimazole, this will bring down levels but of your levels naturally drop it will lower it quicker than needed. 

You need a repeat test within 6 weeks to check levels.  TSH is unreliable the dose will need adjusting based on FT4 & FT3. 

Propranolol can help relieve symptoms and prescribed with carbimazole - are you asthmatic? 

Read carbimazole patient information leaflet carefully.